Provider Demographics
NPI:1790206241
Name:SANFORD, NICHOLAS JAMES (MS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:SANFORD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 N 37TH ST
Mailing Address - Street 2:APT UU-01
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-9697
Mailing Address - Country:US
Mailing Address - Phone:503-720-6637
Mailing Address - Fax:
Practice Address - Street 1:315 129TH ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5044
Practice Address - Country:US
Practice Address - Phone:253-298-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60877190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist